Exploring boundaries of schizophrenia: a comparison of ICD-10 with other diagnostic systems in first-admitted patients.

Abstract

introduction of operational criteria for clinical and research diagnosis in psychiatry was motivated by alarmingly different diagnostic habits among British and American psychiatrists (1). With respect to schizophrenia, at least 15 different diagnostic systems may be identified in the literature over the last three decades (2). operational approach in psychiatry, considered by many as a progress in the right direction, is also being increasingly criticized for serious epistemological shortcomings and for a number of negative pragmatic consequences for psychiatry as a profession (3-7). The [operational] diagnosis has almost become a thing in itself - a certainty of 'concrete dimensions' [...] 'allegedly' being more data based, has even assumed the aura of allowing psychiatry to keep pace with the rest of medicine as a 'technological triumph' (5). Thus, although the contemporary DSM and ICD criteria for schizophrenia are a convention of unknown validity as compared to their potential rival definitions (see 8 for an extensive discussion), these criteria are being increasingly considered by the residents and the younger colleagues as the criteria which somehow must reflect the true nature or essence of this disorder. Needless to say, the official diagnostic criteria exert powerful censoring effects on the editorial and funding policies. The purpose of this study was to revive the issue of boundaries of schizophrenia by comparing the ICD-10 criteria to other diagnostic systems. Special attempt was made to assess the concurrent validity of ICD-10 and ICD-9. study is a part of an ongoing prospective followup investigation of first-admission cases (The Copenhagen Prodromal Study).